Basic Information
| Provider Information | |||||||||
| NPI: | 1285795195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEPPARD | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 NEW HOPE RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044251522 | ||||||||
| FaxNumber: | 3044879447 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 NEW HOPE RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044251522 | ||||||||
| FaxNumber: | 3044879447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 23152 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0166933000 | 05 | WV | MEDICAID | 550612451002 | 01 | WV | MOUNTAIN STATE BCBS | OTHER |